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Discussion

necrotizing fascitis

Just admitted a pt to home health who had necrotizing fasciitis from a perf. ileus. Mds are ordering wound vac with xeroform at 75 mm hg. The wound was closed with vinyl mesh in the OR. The wound is only 0.4 cm deep with minimal drainage. Why is wound vac being used on such a shallow wound that is not draining much? The NP said for wound stabilization. I am wondering if there are other options and when I would DC the wound vac in this situation. Also, the wound bed is curving up to meet the skin, where most wounds I have seen are inverted. Is this safe to be treating? Also, there is a suture present, md notified, will evaluated next week. Is it just me, or how can we initiate wound vac with a suture still in place?

Thanks!

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Just because the wound depth is shallow in your opinion does not mean that this wound cannot benefit from a VAC. The VAC will help keep this wound much cleaner than a regular drsg. With nec. fasc. hx, you don't want any crud buildup in there because it could suddenly get out of control in the hours between drsg changes. It is very possible that the person became infected with the bacteria at home in the first place.

Nec. Fac. can kill someone within literal hours.

Unless your agency will have someone staying with your pt 24/7 and checking the wound every 1-2 hours for a problem - better to suck anything out of there and have a closed wound drsg than risk getting reinfected and having exudate buildup with a regular drsg.

A suture is not going to hinder your VAC unless it is poking through the clear drap and not allowing a good seal.

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